多次复发失败后的肝脏再次移植超过两个移植物。
Liver retransplantation of more than two grafts for recurrent failure.
机构信息
Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
出版信息
Transplantation. 2009 Oct 15;88(7):884-90. doi: 10.1097/TP.0b013e3181b6f20e.
BACKGROUND
Transplantation of more than two livers for recurring graft failure has not been specifically addressed in the literature.
METHODS
A retrospective analysis was conducted from a total of 2527 overall liver transplants at our institution. Main indications for multiple retransplant included primary nonfunction, chronic rejection, hepatic artery thrombosis, and recurrent disease.
RESULTS
We identified 39 patients who received more than two grafts (32 received 3 grafts, 5 received 4 grafts, and 2 received 5 grafts). All patients required interposition arterial grafts from the aorta and hepatojejunostomy for the biliary reconstruction. Seventeen patients are still alive at last follow-up. Perioperative mortality rates after 3rd, 4th, and 5th liver graft were 25%, 14%, and 50%, respectively. Patient and graft survival rates were 72% and 56% at 1 year, respectively. Median length of stay was 27 days and median graft survival was 2.9 years.
CONCLUSIONS
Selection of patients and a significant use of available resources are some of the important factors that clinicians need to take into account when dealing with multiple retransplantations. With such conditions, however, liver retransplantation of more than two grafts can be a life-saving procedure.
背景
在文献中，并未专门针对因移植物反复失功而进行两次以上肝脏移植的情况进行讨论。
方法
我们对本机构总共 2527 例全肝移植进行了回顾性分析。多次肝移植的主要适应证包括原发无功能、慢性排斥反应、肝动脉血栓形成和复发性疾病。
结果
我们共识别出 39 例接受了两次以上供肝（32 例接受了 3 个供肝，5 例接受了 4 个供肝，2 例接受了 5 个供肝）的患者。所有患者均需在主动脉和胆肠吻合处使用间置动脉移植物进行胆管重建。截至最后一次随访时，仍有 17 例患者存活。第 3、4、5 次肝移植后的围手术期死亡率分别为 25%、14%和 50%。1 年时患者和移植物的生存率分别为 72%和 56%。中位住院时间为 27 天，中位移植物生存时间为 2.9 年。
结论
选择患者并充分利用现有资源是临床医生在处理多次肝移植时需要考虑的一些重要因素。然而，在这种情况下，两次以上的肝脏再移植可以是一种救命的手术。
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